Febrile Seizure

Question 1

When should you LP a child with febrile seizure?

Answer 1

• Age < 1 (regardless of semiology and exam)
• Meets criteria for complex febrile seizure
• Age > 5 (regardless of semiology and exam)

Question 2

Past what point is nuchal rigidity a reliable sign for meingitis?

Answer 2

18 months of age

Question 3

Febrile seizure

Answer 3

Generalized seizure associated with a fever, usually exceeding 101 F, typically occuring in a child between 6 months and 5 years of age.

Question 4

Simple febrile seizure criteria

Answer 4

1. Patient is otherwise neurologically healthy
2. Patient’s age is between 3 months and 6 years
3. Seizure is generalized and without focal elements
4. Seizure lasts less than 15 minutes
5. Seizure is associated with a fever (>101 F) that is NOT caused by a CNS infection
6. Seizure occurs only once in a 24 hour period

Question 5

Complex febrile seizure criteria

Answer 5

• Lasts > 15 minutes
• Multiple seizure in less than 24 hours
• Focalizing signs in seizure semiology

Question 6

Symptomatic febrile seizure

Answer 6

Meeting all criteria for a febrile seizure, but having pre-existing neurologic abnormality or acute illness

Question 7

Febrile seizures tend to occur in what time window?

Answer 7

The first 24 hours of a febrile illness

Question 8

Infectious agents more commonly associated with febrile seizures

Answer 8

• HHV6 (most common)
• Adenoviridae
• Parainfluenza
• RSV

Question 9

Generalized epilepsy with febrile seizures plus (GEFS+) syndromes

Answer 9

• Heritable GEFS with highly variable phenotype
• May persist beyeond age 5
• Associated with mutations in voltage-gated sodium channels and GABA receptors

Question 10

Risk for developing epilepsy given a history of febrile seizures as a child

Answer 10

Only ~3%

Question 11

Treatment of febrile status epilepticus

Answer 11

Defined as lasting > 30 minutes (as opposed to >5 minutes otherwise) for febrile seizures. Two components:

Treat the fever (cooling methods, antipyretics)

Treat the status epilepticus (as per normal protocol)

Question 12

If a patient has consistently recurrent febrile seizures, you can. . .

Answer 12

. . . prophylax WHEN THEY ARE FEBRILE OR BECOMING FEBRILE with antipyretics and anticonvulsants

Note that the antipyretics here interestingly does not seem to reduce the risk of seizures.

However, treating with rectal or oral diazepam during a fever does reduce the risk and can abort seizures that have already begun.